Terms of Credit - Lind Electronics

Business Information

Company Name:*

Phone:*

Fax Number:

Billing Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Address:*

Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Type:

DUNN's Number:

Federal ID Number:*

Contact Information

President Name:*

Phone:*

Email Address:*

Controller Name:*

Phone:*

Email Address:*

Accounts Payable Name:*

Phone:*

Email Address:*

References

Bank Name:*

Phone:*

Bank Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number:

Loan Number:

Trade Reference #1

Business Name:*

Phone:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number:

Contact Name:*

Contact Number:*

Contact Email:

Trade Reference #2

Business Name:*

Phone:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number:

Contact Name:*

Contact Number:*

Contact Email:

Trade Reference #3

Business Name:*

Phone:*

Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Account Number:

Contact Name:*

Contact Number:*

Contact Email:

Agreement

1. All of the above information is accurate.
2. Upon approval of credit terms, all invoices are to be paid within 30 days. Any invoice not paid within 30 days is subject to a 1.5% finance charge to be applied and increased every 30 days until paid.
3. All collection fees/legal fees associated with an invoice placed in collections are the responsibility of your company.
4. By submitting this application, you authorize Lind Electronics, Inc. to make inquiries into the banking

Signature

Title:*

Name:*

First Last

Date*

MM

DD

YYYY